Provider Demographics
NPI:1285639567
Name:IOANNIDES, JOANNA (MSW/LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:IOANNIDES
Suffix:
Gender:F
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 S MAIN ST STE 219
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5361
Mailing Address - Country:US
Mailing Address - Phone:720-319-7319
Mailing Address - Fax:303-379-4607
Practice Address - Street 1:6105 S MAIN ST STE 219
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5361
Practice Address - Country:US
Practice Address - Phone:720-319-7319
Practice Address - Fax:303-379-4607
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CO9926741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08105031Medicaid
CO1114379112OtherGROUP NPI